Musings in the life of an internist, cardiologist and cardiac electrophysiologist.

Wednesday, July 24, 2013

When Your 26-year Old Needs Insurance

My son was born in 1987. Like many kids his age, he is currently "underemployed" as he struggles to get an internet start-up idea off the ground. Thanks to our new health care law, he was able to stay on my insurance until he reached the magic age of 26. But the honeymoon has ended and recently I began the process of deciding if I should continue him on my Cobra plan at the high price of $485.14 per month or seek a high-deductible major medical plan instead.

Being former military, I have homeowners and car insurance through USAA. So I was interested when they sent me a marketing e-mail suggesting I might want to look at health insurance options available for my son. The plans were offered by "Assurant Health Care," so I thought I'd explore what this one company offered.

First, Assurant Health offered three options for coverage: (1) Fixed-benefit Insurance starting at $67 per month, (2) Temporary Insurance starting at $86.74 per month, and (3) Major Medical Insurance starting at $90.74 per month. So far so good.

Fixed-benefit insurance, I learned, is different from major medical insurance since it pays set cash amounts (fixed benefits) when a person receives medical services. Depending on what providers charge, my son might (scratch that, probably will) have to pay a portion of his health care bill and cap at a $1 million, $2 million, or $3 million lifetime benefit, depending on much he'd like to pay each month.

Temporary insurance is marketed as "30 to 180 days of short term insurance coverage. Protection is provided when you're between jobs, waiting for employer benefits, or in temporary, seasonal or contract work." Hmm, this seemed like a possibility provided he can get a job in that period of time. Oh wait, this hasn't gone so well so far, so this might not be the best option for him.

Major Medical insurance: was being marketed as insurance similar to what I have now, except with a varying sized deductibles and no life-time care limit.

On the surface, each of these options looked possible until I read the fine print on all of them: pre-existing conditions would not be covered by any of the above plans. But my son has a few pre-existing conditions. Wait, doesn't our new health care law cover people with pre-existing conditions?

As I recall, the Pre-existing Condition Insurance Plan (PCIP) is overseen by the Center for Consumer Information and Insurance Oversight (CCIIO) created through our new health care plan and under the auspices of the Department of Health and Human Services. To be eligible for the PCIP, “individuals must have a pre-existing condition and have been without creditable coverage for at least 6 months prior to application,” explained the Governement Account Office that limits “the program to individuals who likely have been unable to access insurance because of their pre-existing condition.”

Now he just lost his insurance, right? So he has to wait 6 months? Can you say "Catch-22?"

To make matters much worse, the PCIP ran out of money in February, 2013 so the Department of Health and Human Services stopped enrolling patients with pre-existing conditions who might need coverage. What does this mean for the rest of our new health care law's ability to pay for U.S. citizens as insurers offload all their patients with pre-existing conditions on them? Will Congress assure there be enough money available to care for patients with pre-existing conditions when the new health care law goes into effect? And why hasn't this been fixed by now? This should sound a prescient warning concerning correcting problems with the law to us all.

His only other option currently is to enroll in Illinois CountyCare, a Medicaid program constructed on the back of the Affordable Care Act. It provides limited services and not all doctors are part of CountyCare, I learned. In fact, according to their website:

"Only doctors that are part of the CountyCare network may accept CountyCare patients. When an individual enrolls in CountyCare, they will be asked to select a patient centered medical home site from a list of participating providers. Choices will include Cook County Health & Hospital System sites as well as some other community providers, such as community health centers."

But at least he'd have some health care, right?

It is hard to say. He might have insurance, but access to providers might be very difficult, especially when we consider Cook County, the second most populous county in America, has 40.5% of the entire population of Illinois within its border.

Given these options, it appears my son will likely continue his Cobra plan for now, since the devil you know is better than the devil you don't know.

Now I consider myself fairly medically savvy. I read fine print. I am fortunate to have financial resources. And I like the ability to choose between options for my son's insurance needs. But it looks like the depth and breadth of health care options for young adults without pre-existing conditions is going to be staggering but with many coverage loopholes. For those young adults with pre-existing conditions, their options for care will remain quite limited, especially if they're unemployed or underemployed.

I feel for the young, under-employed who are less medically-saavy and have no fallback options for care. Will they obtain the wrong insurance or be underinsured as they fumble through a variety of websites that offer hundreds of coverage options? Will they have to find a new doctor beginning in 2014?

It seems so.

Welcome to the insurance nightmare of the Obamacare Underworld.

-Wes

administration’s Health and Human Services Department (HHS) has stopped enrolling any new people in the program, according to an audit by the General Accountability Office (GAO). - See more at: http://cnsnews.com/news/article/gao-hhs-already-rationing-enrollment-obamacare-s-pre-existing-condition-plan#sthash.EZVgmKIe.dpuf

administration’s Health and Human Services Department (HHS) has stopped enrolling any new people in the program, according to an audit by the General Accountability Office (GAO). - See more at: http://cnsnews.com/news/article/gao-hhs-already-rationing-enrollment-obamacare-s-pre-existing-condition-plan#sthash.EZVgmKIe.dpuf

6 comments:

Anonymous
said...

He could always sign up for the state's medicaid plan, since he's over 26 and 'underemployed'. This should fill the gap until ACA (and its PCIP expansion) kicks in and he's earning enough to enroll in a private plan on his own.

You can correct me if I a wrong, but, Obamacare is jsut what the doctor ordered for your son. The pre-existing qualification will disappear as of January 1st when the new insurance exchanges become availible (these are to appear in October so people can start signing up). Exchanges in California and New York are already showing significant reductions in the premiums charged for individuals and hopefully the same will occur in Illinois.

If not for Obamacare, your son would not have been able to remain on our policy till age 26 and would be subjected to trying to buy insurance on the the open market (actually not so open market it turns out).

I suspect the exchanges will have some start up issues, as did the Medicare drug benefit for seniors when it first started, but once this gets ironed out, your son will have access to affordable insurance and may even get a subsidy from Uncle Sam to defray the cost.

These are very tangible changes in the health care law that will improve access to health care for millions of citizens who will no longer be tethered to their employment as a condition of gaining insurance and will likely see premiums drop significantly.

Well, your son will be rejected by all comprehensive insurance in the individual market with a disqualifying pre-existing condition. So why are you worried about any change? He's SOL right now anyway. Change might get him something.

He's gotta be realistic and look for a job with a group plan, and work on his idea for a business on his off time, or go without insurance. Them's the breaks, he'd better learn 'em.

He might understand it's time to grow up and fend for self, at his age. Time for Dad to step aside. He can have his own business when he has something to offer the world, later...

I'd suggest calling Ted Cruz or John Boehner. Check in with them. They're the ones who understand why there are no funds to cover your son with his pre-existing conditions ("not one cent for Obamacare"). Please get back to us to tell us their solutions...

About Me

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.
DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.